Provider Demographics
NPI:1275595613
Name:FAMILY CARE ASSOCIATES, INC
Entity Type:Organization
Organization Name:FAMILY CARE ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-322-1794
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:191 CHRISTIANA RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3024
Practice Address - Country:US
Practice Address - Phone:302-322-1794
Practice Address - Fax:302-322-3498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1996105387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015490Medicaid
DE1000015490Medicaid
DE761651Medicare ID - Type Unspecified
DE1000015490Medicaid